Antisocial Personality Disorder

He is the bad boy in high school — stealing stuff from other kids and lying about it, picking fights, getting poor grades. But he doesn’t seem to care. Grown up, he’s a con artist — can’’t hold a decent job, thinks life isn’t fair, and he’s still stealing and getting away with it most of the time.

Someone with antisocial personality disorder (ASPD) has a reckless disregard for others and often for himself (most people with antisocial personality disorder are male). He doesn’t want to conform to social norms and willfully destroys property, steals or manipulates others for personal profit, or overindulges in pleasure-seeking behavior. For example, he speeds, drives while drunk, engages in risky sex, or uses drugs.

Life may not seem fair to him because he impulsively bounces from job to job and isn’t successful in relationships. As a husband, he’s an irresponsible failure and a poor parent who neglects his children’s needs and feels no remorse — perhaps he even batters his wife.

If a person with antisocial personality entered the military to “straighten out,” chances are he was dishonorably discharged due to criminal or unethical behavior. Most people with ASPD find it difficult to hold down a job that requires rigorous attention to authority and duty.

A person with ASPD may often be arrogant, even cocky. Yet someone with antisocial personality disorder can also be charming while manipulating others for his own gain. He has little concern about his current problems and certainly not for the future. He defaults on debts and can end up homeless, if not imprisoned. Ultimately, he is more likely than other individuals to commit suicide or die by violent means, such as an accident.

The guiltless pattern of social irresponsibility demonstrated by someone with antisocial personality disorder begins in early childhood or adolescence. Antisocial behaviors range from relatively minor acts, such as lying or cheating, to heinous acts, including torture, rape, and even murder. While not all criminals have ASPD, most people with ASPD do find themselves in trouble with law enforcement at least once in their lives.

Though widespread, the a person with ASPD feels that their importance is rarely acknowledged or recognized. As psychiatrist Hervey Cleckley once noted, the person with antisocial personality disorder is “the forgotten man of psychiatry who probably causes more unhappiness and more perplexity to the public than all mentally disordered patients combined.” Some believe that people with antisocial personality disorder seem to have little regard for other people’s well-being and may not possess the same kind of conscience that most people ordinarily have.

This serious personality disorder is difficult to treat and only half of those treated show some reduction in antisocial behaviors. For this disorder, the best treatment may be in preventing children with conduct disorders to continue their destructive paths into adulthood. Treatment can help a person with antisocial personality disorder, but only if they seek out help and honestly want to change. This may be a difficult thing for many with ASPD to acknowledge.

What are the symptoms of ASPD? Can it be treated?

People with antisocial personality disorder often live a life in conflict with others, because they don’t understand the normal rules and laws that most people in society follow.

Donald Black, MD

Donald Black, MD received his medical degree from the University of Utah College of Medicine. He currently is a professor of psychiatry at the University of Iowa College of Medicine. Dr. Black is the author of Bad Boys, Bad Men -- Confronting Antisocial Personality Disorder and his work has been profiled on television programs such as 20/20, Dateline, and 48 Hours.